Hi Jasmin20, I'm in a similar situation in that 2 weeks after my latest bleed started, despite using Vagifem 5 nights a week throughout (& Estriol externally) I'm still sore & dry though finally starting to see a little healthy moisture return. My bleeds tend to last 10 days or so (long cycle regimen), so the normal flora probably get really disrupted & all the good from topical oestrogen is temporarily undone.
A gynae told me in early peri to avoid tampons as he said they are less suitable as we age. He didn't explain that comment & I ignored him at first as I hated using towels, but soon found tampons were getting torn on removal because of dryness towards the end of a bleed. He must have had VA in mind but at that stage I'd never even heard of it. I'm reluctant to suggest you might think about using towels instead but just passing on his advice & what happened to me.
I'm not on vaginal prog & one reason for that was because I found it worsened my VA, so if you need to use it that way I think you are in a difficult situation. But taking oral MPA does that to me even before the bleed starts, though to a lesser extent than vaginal Utro did.
I haven't used Imvaggis, but wonder whether your VA might respond better to Vagifem if you haven't tried that? I see Imvaggis is an Estriol preparation, so a weaker form of oestrogen than the oestradiol in Vagifem. Vagifem 5 nights a week with 0.01% Estriol thinly applied externally (plus low dose systemic) helps keep me comfy most of the time, though even that doesn't replicate the comfort I had before peri began, ooh eons ago now!
I can't really answer whether you should increase your systemic oestrogen or wait for the effects of the topical to reassert themselves, except to suggest you choose whichever you are more (psychologically) comfortable with for now. You can always review that decision later if need be.
If you decide to up your systemic, do you have any of the Estradot 75mcg patches left (I think you were on these a couple of weeks ago when we last chatted) rather than having to get your GP to prescribe more gel? Or did you stop those because of the headaches etc they seemed to be causing?
Another thought is that some form of conti regimen (with oral or transdermal prog or maybe an IUD), by avoiding bleeds after the settling in stage, should not interfere with the effects of your topical HRT to the same extent if you are in a position to go back to that rather than carry on with sequi.
Sorry, this probably isn't much help.
